HomeMy WebLinkAboutThurston-Mason Behavioral Health Amendment # 1tY1C Conkva0 20 06
THURSTON-MASON BEHAVIORAL HEALTH
ADMINISTRATIVE SERVICE ORGANIZATION (TM BH-ASO)
AMENDMENT TO THE
INTERLOCAL AGREEMENT FOR INVOLUNTARY JUDICAL SERVICES
WITH MASON COUNTY SUPERIOR COURT
Provider:
Contact:
Phone:
Mason County Superior Court
Robyn Lockwood
360 427-9670 ext. 206
Title:
Email:
Mailing Address: PO Box X, Shelton, WA 98584
Agreement
Number:
2021
New Start Date: January 1, 2021
Thurston -Mason BH-ASO Contacts:
Court Administrator
RL@co.mason.wa.us
Amendment Number:
New End Date:
December 31, 2021
Tara Smith, Finance Director
Mark Freedman, ASO Administrator
Phone:
360.763.5809
Email:
Phone:
360.763.5791
Email:
Mailing Address:
Phone:
Email:
to ra. s m ith Ptm b h o .org
mark.freedman@tmbno.org
612 Woodland Square Loop SE, Ste 401, Lacey WA 98503
INCORPORATION OF EXHIBITS AND ATTACHMENTS
The Provider shall provide services and comply with the requirements set forth in the following attached exhibits, attachments,
or any other materials which are Incorporated herein by reference. To the extent that the terms and conditions of any Exhibit or
Attachments conflicts with the terms and conditions of this base contract, the terms of this Contract shall control.
This Contract Amendment, including all Exhibits and other attachments incorporated by reference, contains all of the terms and
conditions agreed upon by the parties as changes to the original contract. No other understandings and representations, oral or
otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or bind the parties. Ail other
terms and conditions of the original Behavioral Health Services Contract and preceding amendment remain In foil force and
effect. The parties signing below warrant that they have read and understand this Contract Amendment and have authority to
enter into this Contract Amendment. By their signatures below, the parties hereto agree to this Contract Amendment.
Contractor Signature:
Printed Name and Title:
Viea;-\ e v\ vo .
Printed Name and Title:
Mark Freedman, CEO
Date:
1J\uI21
Date:
z7.2.
i
TM BH-ASO Amendment #1 to Interlocal Agreement #
Page 1 of 2
The Interloca I Agreement for Judicial Services, between Thurston -Mason BH-ASO and Mason County Superior
Court is hereby amended as follows:
4. Funding
a) Total amount to not exceed $50,000 annually shall remain the same as will the $25,000 for costs associated
with supplies, equipment, trials, jury expenses and other verified expenses.
b) Sharing Protected Health Information: The parties agree that information shared under this agreement Is
shared for the purpose of coordination of treatment and/ar health care operations. The parties also agree
not to use or disclose protected health Information other than as permitted or required by this Agreement,
HIPAA and the Health Information Technology for Economic and Clinical Health Act (HITECH). The parties
shall use and disclose protected health Information only if such use or disclosure, respectively, in compliance
with each applicable requirement of 45 CFR Section 164.504(e)
Except as expressly provided by this Amendment No. 01, all other terms and conditions of the original
lnterlocal Agreement as signed by Mason County on February 4, 2020, for Judicial Services and preceding
amendment remain In full force and effect.
TM BH-ASO Amendment #1 to lnterlocal Agreement #
Page 2 of 2